STEAMBOAT SPRINGS — The RV will hit the road for a different northwest Colorado town each day, carrying urine toxicology tests, opioid-overdose antidotes, a counselor and a nurse.
Sundays at the Mercantile in Hayden. Wednesdays at the Safeway in Fraser. Thursdays at the City Market in Granby.
The rig is one of six that soon will travel throughout rural Colorado, an effort to bring opioid-addiction treatment to people who have none where they live.
“We want to bring it to the frontier towns,” said Nancy Smith Beste, executive director of Mountain Medical Road to Recovery, the Steamboat addiction treatment clinic that will operate the RV for the northwest region. Other stops on its route will include Kremmling and Oak Creek.
Three of Colorado’s six RVs already are on the highway, parking in small towns in the northeast corner of the state, the southeast and the San Luis Valley. The other three are still under construction to turn the vehicles into mobile medical clinics, with bathrooms to collect urine samples, a nurse’s station and a private room for counseling sessions. Each will travel hundreds of miles per week.
The goal is that each of the six vehicles eventually will see at least 50 patients per week, providing medication-assisted treatment for those who are addicted to heroin or prescription opioids. Visits are by appointment or walk-in, and staff have been spreading the word at medical clinics, hospitals and shelters.
The towns were chosen by the state Office of Behavioral Health after officials reviewed data on overdose deaths and maps showing the areas of the state that have no clinics or doctors who prescribe medication-assisted treatment. The medicine to treat opioid addiction, buprenorphine, is a synthetic opioid used to eliminate withdrawal symptoms and has a low risk of overdose. It comes in pills, a patch or injection.
Unlike methadone, which is dispensed at clinics strictly regulated by federal law, buprenorphine is available through prescription from physicians. The number of providers in Colorado willing to write those prescriptions has grown to nearly 1,800 in recent years, but stigma and prejudice about the people who seek the drug — sold under the brand name Suboxone — have prevented widespread access, said Robert Werthwein, director of the state Office of Behavioral Health.
The six RVs are funded through a $6.7 million grant to Colorado from the federal Substance Abuse and Mental Health Services Administration, which has awarded the state more than $45 million since 2017 for opioid addiction treatment and prevention. The funds have purchased almost 42,000 overdose kits that include naloxone, which can reverse the effects of an overdose, and were spent opening clinics, training doctors to prescribe buprenorphine and providing the medication in 16 county jails.
The idea for the traveling RVs came after Werthwein heard about a similar effort in New York while attending a conference two years ago. Besides helping people right away, a longer-term goal of the mobile units is to show local physicians how many people in their community need medication-assisted treatment — and spurring them to start prescribing the drugs.
“There are some providers that are not aware that there is need in the community,” Werthwein said, noting opioid addiction is a “pretty widespread disease that covers a lot of individuals.”
“They are sicker than dogs”
When Beste, of Mountain Medical Road to Recovery, moved from the Denver area to Steamboat in 2017 to open the town’s first medication-assisted treatment center, she didn’t quite feel welcomed. “There was a lot of stigma when we got here, people saying it was trading one drug for another,” she said, meaning locals did not see the benefit of prescribing synthetic opioids to people who were trying to stay off heroin. “They were really hesitant.”
Since then, Mountain Medical has “inducted” 160 clients into medication-assisted treatment. “It might not sound like a lot, but every time we say, ‘We saved another life,’” Beste said.
The Mountain Medical clinic opened in Routt County, one of the Colorado counties hardest hit by the opioid epidemic, thanks to a state grant. Clients include those who are homeless and destitute, as well as those who started with prescription opioids after getting injured skiing or cycling, and later turned to heroin, Beste said.
“We have people who come in that nobody knew they were using heroin,” she said. “They say, ‘It’s taking all my money and my wife doesn’t know.’ You can’t tell. Most of the time you cannot even tell unless you really look at their pupils. And if they don’t use, they are just sicker than dogs.”
A few clients drive from far-flung towns like Hayden, Oak Creek and even Winter Park, to seek help for their addiction. Sometimes they hitchhike to get there. And sometimes they stop coming because it’s easier to buy heroin where they live, Beste said.
Even though the clinic has yet to get its RV, staff began setting up weekly pop-up clinics in rural towns in November.
Beste, who helped one of her sons and a stepson through treatment for heroin addiction before becoming a certified addiction counselor, couldn’t quit thinking about people in rural Colorado who needed help — “people who have lost their kids and are now about to suddenly feel healthy and well and not have to go out and search for heroin or alcohol,” she said. “People who had given up.”
“Urgent care for addiction”
Each RV will have a nurse, an addiction counselor and a peer coach who is in recovery from addiction. The rigs — with satellite capacity — will use telehealth to connect a patient with a doctor who can write prescriptions.
Front Range Clinic, which opened about five years ago in Fort Collins and now has 19 clinics from northern Colorado to Grand Junction and in Farmington, New Mexico, will operate three of the six RVs.
One is already traveling all the way to Julesburg in the northeast corner of the state, with weekly stops in Sterling, Limon, Burlington, Holyoke and Sedgwick. Another sets up in parking lots in La Junta, Las Animas, Walsenburg, Springfield and Trinidad. And a third, coming-soon RV will head south from Colorado Springs to the mountain town of Westcliffe, plus Woodland Park, Fairplay, Buena Vista and Bailey.
Front Range Clinic also has 15 pop-up clinics — including in homeless shelters and needle-exchange programs, said Dr. Clark McCoy, president of the clinic. He views all of the clinics — the buildings, the pop-ups and the RVs — as “urgent care for addiction.”
“Our mission is to get evidence-based addiction treatment to underserved populations,” he said, noting that all the clinics take Medicaid, private insurance and clients with no insurance. “Our model is low-barrier, high-access.”
Staff in pop-up clinics have been telling people for months to spread the word about the RVs, and while some towns turn out only a handful of patients, others have kept staff busy. About 70% of Front Range’s patients addicted to opioids were using heroin, compared with 30% prescription opioids, he said. A growing number are also using fentanyl, he said.
“We come to them”
Tonja Jimenez, a peer specialist who works in the RV that starts in Greeley each morning and heads east toward Kansas, began using meth, including intravenously, in 2010. Her ex-husband kicked her out when he found a meth pipe in their house, which sent her further into drug use and living in motels.
It wasn’t until 2012, after she had been arrested and found meth within 36 hours of posting bond, that she realized she was addicted.
“It scared me,” she recalled. Jimenez turned herself into jail and waited for placement in a treatment clinic in Greeley.
After treatment, she started life over again — got a job at a butcher shop, rented a room in an apartment, reestablished a relationship with her two kids, and earned a degree in psychology from the University of Northern Colorado.
Now she counsels people who come to the mobile clinic. One woman showed up sick from withdrawals, which heroin-users describe like the worst flu — “You feel like you want to jump off a bridge for the first week or more. You can’t eat. You can’t sleep. You are just throwing up and can’t pull yourself out of bed,” Jimenez said. The woman was pale, hardly speaking and “you could tell she hadn’t showered in days,” Jimenez recalled.
The RV staff helped her get a prescription and a counseling session, and the next time the woman came back for a drug screen and prescription renewal, she was a different person. “She was laughing and telling me about her visit with her kids,” Jimenez said. “She was just full of life.”
Jimenez, who started working on the RV late last year, rolled into Limon one mid-morning last week. “We come to them,” she said. “We are giving people hope who didn’t have any.”